UMEM Educational Pearls

Category: Neurology

Title: Dihydroergotamine (DHE) for Treating Headache

Keywords: DHE, dihydroergotamine, migraine headache, headache, cluster headache (PubMed Search)

Posted: 1/30/2008 by Aisha Liferidge, MD (Updated: 7/14/2024)
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  • Dihydroergotamine (DHE) is an older medication approved for the treatment of intractable migraine and cluster headaches.  Many of our Neurology colleagues still use this drug and its administration could start while the patient is 
    in the ED.
  • Intranasal forms have become popular (i.e. Migranal).  Intramuscular and subcutaneous administration are also possible.
  • The typical intravenous dose is 0.25 to 1 mg IV push over 2-3 minutes q 6 hours for 24 to 72 hours.
  • DHE use is contraindicated in the following patients

       Patients concurrently on a protease inhibitor or macrolide antibiotic because of increased risk of life- threatening 
    peripheral ischemia (**Black Box Warning**) 
    >    Patients with a hypersensitivity to ergot alkaloids 
    >    Patients with increased risk of developing vasospastic events 
    >    Patients who are concurrently taking vasoconstrictors 
       Patients who are pregnant or nursing 
       Patients with hemiplegic or basilar migraines
  • Monitor for the following potential adverse reactions, which are typically related to vasoconstriction/spasm
    and warrant immediate abortion of the drug’s administration: 

    >    Myocardial infarction (check ECG's)
    >    Arrhythmia (place on cardiac monitor)
    >    Stroke (regular neuro. checks)
    >    Hypertension (check often) 
       Ischemia (monitor for clinical signs/symptoms) 

    -- Diener HC, Kaube H, Limmroth V. A practical guide to the management and prevention of migraine. Drugs. 1998;56(5):811-824.
    -- Fisher M, Gosy EJ, Heary B, Shaw D. Dihydroergotamine nasal spray for relief of refractory headache: A retrospective chart review. Curr Med Res Opin. 2007;23(4):751-755.